Autogenous mucochondral-osteal nasoseptal graft for reconstruction of orbital floor: a preliminary study
Keywords:Nasoseptal graft, Maxillectomy, Malignant tumors, Maxillofacial, Pedicled graft
Resection of malignant sinonasal/skull base tumors that erode the orbital floor often result in large defects. We describe a technique for orbital floor reconstruction using a structural pedicled mucochondral-osteal nasoseptal flap (PMCONSF) that includes both soft tissue and bony-cartilaginous components with a continuous pedicled vascular supply. Case presentation was 11 patients having tumors associated with midface requiring maxillectomy and removal of inferior wall of orbit were included. Reconstruction of floor of orbit was done using PMCONSF. Post-operative outcomes of the techniques were studied. In all 11 cases reconstruction of floor of orbit was done using pedicled nasoseptal cartilage and in none of the cases communication of the orbital content with maxillary sinus was encountered. Complete ophthalmic examination revealed no significant diplopia, no entrapment of ocular structures with good ocular motility. Adequate reconstruction of the orbital floor is crucial to maintaining long-term ocular function. The PMCONSF offers great flexibility in flap design as well as a high rate of success. The bony-cartilaginous component offers a rigid structural part to the orbital floor, eliminating the functional defects that can occur from anatomical changes. The pedicled vascular supply helps assist in graft integration, limiting the potential for graft rejection or necrosis following postoperative radiotherapy. We believe that this graft offers a viable alternative to existing methods for orbital reconstruction in patients with large orbital floor defects, especially for cases in which adjuvant postoperative radiotherapy is anticipated.
Sharma SK, Sawangdee Y, Sirirassamee B. Access to health: women's status and utilization of maternal health services in Nepal. J Biosoc Sci. 2007;39(5):671-92.
Li KK. Repair of traumatic orbital wall defects with nasal septal cartilage: report of five cases. J Oral Maxillofac Surg. 1997;55(10):1098-102.
Suárez C, Ferlito A, Lund VJ, Silver CE, Fagan JJ, Rodrigo JP, et al. Management of the orbit in malignant sinonasal tumors. Head Neck. 2008;30(2):242-50.
Bayat M, Heravi F, Khalilzadeh O, Mirhosseni Z, Tari A. Comparison of conchal cartilage graft with nasal septal cartilage graft for reconstruction of orbital floor blowout fractures. Br J Oral Maxillofac Surg. 2010;48(8):617-20.
Lai A, Gliklich RE, Rubin PA. Repair of orbital blow-out fractures with nasoseptal cartilage. Laryngoscope. 1998;108(5):645-50.
Jegoux F, Malard O, Goyenvalle E, Aguado E, Daculsi G. Radiation effects on bone healing and reconstruction: interpretation of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(2):173-84.
Liu JK, Schmidt RF, Choudhry OJ, Shukla PA, Eloy JA. Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgery. Neurosurg Focus. 2012;32(6):7.
Eloy JA, Shukla PA, Choudhry OJ, Singh R, Liu JK. Challenges and surgical nuances in reconstruction of large planum sphenoidale tuberculum sellae defects after endoscopic endonasal resection of parasellar skull base tumors. Laryngoscope. 2013;123(6):1353-60.
Eloy JA, Choudhry OJ, Christiano LD, Ajibade DV, Liu JK. Double flap technique for reconstruction of anterior skull base defects after craniofacial tumor resection: technical note. Int Forum Allergy Rhinol. 2013;3(5):425-30.
Eloy JA, Patel AA, Shukla PA, Choudhry OJ, Liu JK. Early harvesting of the vascularized pedicled nasoseptal flap during endoscopic skull base surgery. Am J Otolaryngol. 2013;34(3):188-94.
Talesh KT, Babaee S, Vahdati SA, Tabeshfar Sh. Effectiveness of a nasoseptal cartilaginous graft for repairing traumatic fractures of the inferior orbital wall. Br J Oral Maxillofac Surg. 2009;47(1):10-3.